Provider Demographics
NPI:1154318137
Name:PIERCE, MEG (PA)
Entity Type:Individual
Prefix:
First Name:MEG
Middle Name:
Last Name:PIERCE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 LAKEBRIDGE PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5157
Mailing Address - Country:US
Mailing Address - Phone:386-677-9044
Mailing Address - Fax:386-677-3083
Practice Address - Street 1:400 LAKEBRIDGE PLAZA DR
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5157
Practice Address - Country:US
Practice Address - Phone:386-677-9044
Practice Address - Fax:386-677-3083
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101472207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP39439Medicare UPIN
FLE6146ZMedicare PIN
FLK0993Medicare PIN